Alzheimer's Disease Treatment
Alzheimer’s is a neurodegenerative complex disease in which brain cells die and gets damaged and the connections between them are lost. Currently, there is no cure and no medications are available to treat it completely. Once a person starts showing symptoms of this disease such as memory loss and cognitive function disabilities, they get worse and progress over a time period as a result of the disease progression and brain cells damage.
Although current medication cannot completely cure this disease, they help in reducing some of the symptoms and to stop or slow down from progressing, certain symptoms such as memory loss, behavioral changes, mood swings, and confusions. Current medicinal treatment helps a lot in limiting the progression and focus on extending or slowing the time period of disease progression.
Several drugs prescribed by doctors and approved by the U.S Food and Drug Administration which helps in treating and diagnosing people with Alzheimer’s are there. The treatment of symptoms provide patients with a longer time period for life, comfort, confidence, independence, dignity, and encourage their families and care givers too.
The drugs approved by the U.S FDA for treatment of this disease modulate neurotransmitters which are either acetylcholine or glutamate and the standard medical treatment include cholinesterase inhibitor and agonist of partial N-methyl-D-aspartate (NMDS).
Secondary symptoms of the disease such as depression, aggression, hallucination, confusion, sleep problems, and delusions can be problematic and these behavioural symptoms are common and can lead to cognitive and functional impairment. Following psychopathic drugs are used to treat secondary symptoms:
- Antiparkinsonian agents
- Antiepileptic drugs (for their effects on behavior)
Most of the medicines work best at early stage of the disease progression and help in keeping memory loss, cognitive impairment from getting worse over period of time the in disease condition.
As Alzheimer’s is a progressive disease, its medical treatment is divided according to the disease stages and symptoms. Before starting any medical treatment, choosing the right treatment option is necessary so that proper medicines are given according to the signs and symptoms, and stage of the disease.
Deciding About the Treatment Options
Decision about the treatment options is based on the following information gained by doctors through patient analysis-
- Patient’s age, overall health and medical history
- Severity of the disease
- Effectiveness of the medicines and therapies for a patient and his lifestyle
- Treatment preferences of family and caregivers
Treatment and Medications for Mild (Early) to Moderate Alzheimer’s
Early diagnosis and treatment of Alzheimer’s helps to maintain good level of cognitive and functional ability in patients as long as possible. The drugs which are approved and prescribed to treat early to moderate stage of disease belongs to class of drugs called Cholinesterase inhibitors . These inhibitors are prescribed to treat memory loss, language, judgment, thinking and other early stage cognitive impairment. Cholinesterase inhibitors help in preventing the symptoms from getting worse for some period of time and also help in controlling certain behaviouralsymptoms. These medicines are such as Razadyne® (galantamine), Exelon® (rivastigmine), and Aricept® (donepezil). Cholinesterase inhibitors along with mental exercise help in delaying cognitive function loss in Alzheimer’s patients.
Currently, scientists do not know how do cholinesterase inhibitors work but researchers suggest that they prevent breakdown of acetylcholine (a chemical of brain that is important for memory and thinking). As the brain damages due to the disease progression, the production of acetylcholine reduces eventually.
What Are Cholinesterase Inhibitors?
The acetylcholine level in the brain of an Alzheimer’s disease patient is found to be lower. Acetylcholine is a chemical messenger that hhelps sendmessages and communicate between nerve cells. Loss of the nerve cells is also seen in Alzheimer’s patients. A fall in the level oof acetylcholine and nerve cell damage leads to worsening of the condition.
Cholinesterase inhibitors provide neurotransmitter i.e. acetylcholine and prevents breakdown of acetylcholine by enzyme acetylcholine sterase iin therain. This results in improving concentration of neurotransmitter in our brain and thus increases communication between the brain cells and ultimately helps in reducing and stabilizing neuropsychiatric symptoms of Alzheimer’s such as depression, anxiety, agitation.
Three commonly prescribed cholinesterase receptors are:
- Donepezil (Aricept): This drug was patented as brand name Aricept, but is more widely available as generic donepezil. It is an aapproved medicine treat all stages of Alzheimer's. One can take it as a tablet which can be swallowed or dissolved in mouth.
- Rivastigmine (Exelon): This drug was patented as Exelon and is now available as generic rivastigmine and as well as in other brands. It is approved to treat mild to moderate Alzheimer's. One can take it as a tablet or as a capsule and in liquid form too.
- Galantamine (Razadyne): This drug was patented as Reminyland and is approved to treat mild to moderate Alzheimer's. Patient can take it in the capsule or liquid form or can wear a skin patch having this drug.
Common side effects of Cholinesterase inhibitor include:
Loss of appetite, sleep problems, nausea, diarrhoea, and slow heart rate and blockage in people with cardiovascular condition are the most common side effects.
Working of all the three cholinesterase inhibitors is similar but the type chosen by your doctor for you is based on the which suits the patient more.
Treatment and Medication for Moderate to Severe Alzheimer’s
A second medication type which is an N-methyl D-aspartate receptor agonist called as Mematine (Namenda) is used mainly to treat moderate to severe Alzheimer’s symptoms. This drug was patented as Ebixa originally and is now available in market as generic Mematine. It is a U.S Food and Drug Administration (FDA) approved drug which helps Alzheimer’s patients as follows:
- Delays progression of the symptoms of moderate to severe Alzheimer’s disease
- Helps patients with Alzheimer’s to do their daily activities a little more as compared to the condition without medication
- Maintains and improves memory, attention, language, reasoning and ability to perform simple tasks.
- Helps in regulating activity of glutamate (chemical involved in storage and retrieval of information and information processing)
- This drug works by blocking and limiting excess release of glutamate in the brain, as its amount is found to be excessive in the brain of Alzheimer’s patients.
Namzaric: It is combination of Namenda and Aricept and is best for people who are taking these two drugs separately to treat moderate to severe Alzheimer’s.
Some evidences showed that taking Mematine in combination with Cholinesterase inhibitor benefits in controlling Alzheimer’s symptoms more effectively.
Side effects: Main side effects of Namzaric include headache, confusion, constipation and dizziness.
Treatment of Secondary Symptoms associated with Alzheimer’s Disease
Sometimes other conditions like sleeplessness, depression and behavioural symptoms like wandering, agitation, restlessness, aggression, and psychotic behavior increase or worsen the disease. Their effects range from mild and temporary to permanent effects. No any specific drug dose is proven and accepted for this wide range of clinical manifestations of the disease. Scientists are studying and learning about these symptoms and trying to find new treatments which can involve drug or non- drug based management of these conditions.
Researchers showed that treating the behavioural symptoms helps in managing the disease and people with Alzheimer’s easier.
Behavioural symptoms management
There are some medicines which help to treat and manage behavioural symptoms such as aggression, depression, anxiety and restlessness. These
medicines should be used only after trying other non-drug based treatment strategies to treat the condition. These medication include:
- Celexa® (citalopram)
- Remeron® (mirtazapine)
- Zoloft® (sertraline)
- Wellbutrin® (bupropion)
- Cymbalta® (duloxetine)
- Tofranil® (imipramine)
Medications to be Used with Caution
Certain medicines such as sleep aids, antipsychotics, anxiety drugs should be taken with great caution. One should discuss about the risk and side effects with a doctor before taking them. One should use them only after considering other non-drug options which do not help in the problem.
Sleep aids: Usually people with Alzheimer’s face sleeping problems and they may take sleep aids. This helps people get sleep and stay asleep. But it is recommended that Alzheimer’s patients do not use these drugs often because these drugs may increase confusion and risk of falls. Some of the examples of these medicines are:
- Ambien® (zolpidem)
- Lunesta® (eszopiclone)
- Sonata® (zaleplon)
Anti-anxiety: These drugs help in treating anxiety in Alzheimer’s patients. Sleepiness, confusion and dizziness and falls are often caused by these drugs. Therefore, your doctor may advice to take these for short time periods only. Some examples are:
- Ativan® (lorazepam)
- Klonopin® (clonazepam)
Anticonvulsants: These drugs are used to treat aggressive behaviour. Dizziness, sleepiness, confusion, and mood swings may be possible side effect. Examples are:
- Depakote® (sodium valproate)
- Tegretol® (carbamazepine)
- Trileptal® (oxcarbazepine)
Anti-psychotics: These drugs are used to treat hallucination, paranoia, and agitation. Their side effects are serious and may lead even to death. These drugs should only be given to Alzheimer’s patients when the symptoms are severe and beyond control. Some examples of these drugs include:
- Risperdal® (risperidone)
- Seroquel® (quetiapine)
- Zyprexa® (olanzapine)
New Treatment Research
Various immunotherapies, drug therapies, cognitive training, and physical activities are now under trial to treat other intervention of Alzheimer’s disease like cardiovascular disease and diabetes. Current Alzheimer’s disease research has been focused to think about pointing other underlying disease processes as well other and not just treating the symptoms only.